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Urgent changes needed to global guidelines designed to stop surgical infection

Wound infections are the most common problem after surgery, particularly in developing countries, but promised innovations to tackle the issue do not work, according to new research findings from an NIHR-funded study.

Both World Health Organisation (WHO) and the NIHR guidelines recommend that surgeons use alcoholic chlorhexidine skin preparation and triclosan coated sutures to prevent Surgical Site Infection (SSI).

However, the world’s largest wound infection trial, could not demonstrate superiority of these interventions over lower cost alternatives. 

Researchers from the FALCON trial, are calling for guidelines recommending these measures, either specifically to Low and Middle Income Countries (LMIC) or at a general global level, to be revised.

Co-author Mr. Aneel Bhangu, from the University of Birmingham, said: “Surgical site infection is the world’s most common postoperative complication - a major burden for both patients and health systems. We have delivered the biggest trial of its kind, where we could not demonstrate the superiority of these interventions over cheaper alternatives.

“Our findings are hugely important for a wide range of care providers in LMICs, as following existing WHO and NICE guidelines, which have significant cost implications for organisations which have limited resources.”

Patients who develop SSI experience pain, disability, poor healing with risk of wound breakdown, prolonged recovery times and psychological challenges. 

Those patients in LMICs are disproportionately affected by higher rates of SSI compared to those in high-income countries - increasing the risk of catastrophic expenditure, impoverishment, and wider negative community impact.

The NIHR Global Research Health Unit on Global Surgery trial, published in The Lancet, covered 5,788 patients from 54 hospitals in seven countries, a broad and representative range, including adults and children undergoing contaminated/dirty surgery, emergency surgery and cesarean section.

Co-author Professor Adesoji Ademuyiwa, from the University of Lagos, said: “The overall SSI rate was very high at 22% - a preventable complication that is causing unnecessary suffering and burden to patients and systems. 

“It is clear that small randomised trials should now be avoided and should be replaced with larger trials that can provide more robust evidence on the incidence of SSI, ultimately leading to more effective measures to help tackle this global healthcare challenge.”

The project has been funded by the Global Health Research (GHR) Programme.

For more information please see the project page.